Implementation, process, and outcomes of nutrition best practices for infants <1500 g

Corrine Hanson, Julie Sundermeier, Laura Dugick, Elizabeth Lyden, Ann L. Anderson-Berry

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Background: Extrauterine growth restriction (EUGR; weight ≤10th percentile) affects many infants ≤1500 g birth weight (BW). EUGR is associated with poor neurodevelopmental outcomes. The objective of this study was to evaluate the impact of optimizing nutrition administration in infants ≤1500 g. Methods: A retrospective chart review compared infants ≤1500 g before (n = 32) and after (n = 49) implementation of nutrition practice changes designed to decrease EUGR. Changes included early aggressive parenteral nutrition (PN), early enteral feedings, trophic feedings, continuous feeding administration, protein fortification of 24-cal/oz mother's own breast milk, and development of a "feeding intolerance" algorithm. The authors evaluated demographics, growth parameters, secondary feeding, and discharge outcomes. Differences in subgroups of infants ≤1000 g and 1000-1500 g BW were assessed. Results: Implementation of the nutrition practice changes decreased EUGR as defined by weight ≤10th percentile at discharge from 57% in the preimplementation group to 28% in the postimplementation group (P =.01). Weight percentile ranking at 36 weeks' gestational age increased significantly in infants 1001-1500 g, from the 13th to the 27th percentile (P =.004 and P =.01, respectively). Chronic lung disease decreased significantly (P =.02). There was no increase in necrotizing enterocolitis (6% pre vs 3% post) or in blood urea nitrogen. Days of PN and central line use were decreased (P =.02 and P =.07, respectively). Conclusions: Clearly defined changes in nutrition for infants ≤1500 g significantly improved growth outcomes without increasing undesired outcomes.

Original languageEnglish (US)
Pages (from-to)614-624
Number of pages11
JournalNutrition in Clinical Practice
Issue number5
StatePublished - Oct 2011


  • growth
  • infant
  • infant, premature
  • nutrition

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics


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